Senior Care Records.

Facility Evaluation Report

Pine Hollow Care Home, Antelope10/08/2021Licence 347004307

Capacity6
Census4
Date signed10/08/2021 04:32:14 PM
The inspector’s account

LPA Williams arrived on Friday, October 8, 2021 to open a separate complaint investigation. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

LPA was screened at front door. LPA met with Tatyana Matskevich, Administrator, and requested an Appraisal/Needs and Services Plan, amongst other things. The facility does not have an Appraisal/Needs and Services Plan.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction